Provider Demographics
NPI:1851401269
Name:VALE, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:VALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 EAST MAIN ST
Mailing Address - Street 2:SUITE 2-7B
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7937
Mailing Address - Country:US
Mailing Address - Phone:631-271-2769
Mailing Address - Fax:631-271-2769
Practice Address - Street 1:205 EAST MAIN ST
Practice Address - Street 2:SUITE 2-7B
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7937
Practice Address - Country:US
Practice Address - Phone:631-271-2769
Practice Address - Fax:631-271-2769
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127689207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00688151Medicaid
B77644Medicare UPIN
NY00688151Medicaid